title: Does blood transfusion affect intermediate survival after coronary artery bypass surgery?
abstract: BACKGROUND
  The aim of this study was to investigate the impact of transfusion of blood products on intermediate outcome after coronary artery bypass surgery.
  
  
  METHODS
  Complete data on perioperative blood transfusion in patients undergoing coronary artery bypass surgery were available from 2001 patients who were operated at our institution.
  
  
  RESULTS
  Transfusion of any blood product (relative risk = 1.678, 95% confidence interval = 1.087-2.590) was an independent predictor of all-cause mortality. The additive effect of each blood product on all-cause mortality (relative risk = 1.401, 95% confidence interval = 1.203-1.630) and cardiac mortality (relative risk = 1.553, 95% confidence interval = 1.273-1.895) was evident when the sum of each blood product was included in the regression models. However, when single blood products were included in the regression model, transfusion of fresh frozen plasma/Octaplas® was the only blood product associated with increased risk of all-cause mortality (relative risk = 1.692, 95% confidence interval = 1.222-2.344) and cardiac mortality (relative risk = 2.125, 95% confidence interval = 1.414-3.194). The effect of blood product transfusion was particularly evident during the first three postoperative months. Since follow-up was truncated at 3 months, transfusion of any blood product was a significant predictor of all-cause mortality (relative risk = 2.998, 95% confidence interval = 1.053-0.537). Analysis of patients who survived or had at least 3 months of potential follow-up showed that transfusion of any blood product was not associated with a significantly increased risk of intermediate all-cause mortality (relative risk = 1.430, 95% confidence interval = 0.880-2.323).
  
  
  CONCLUSIONS
  Transfusion of any blood product is associated with a significant risk of all-cause and cardiac mortality after coronary artery bypass surgery. Such a risk seems to be limited to the early postoperative period and diminishes later on. Among blood products, perioperative use of fresh frozen plasma or Octaplas seems to be the main determinant of mortality.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: R
authors.initials: R
authors.lastname: Mikkola
authors.forename: J
authors.initials: J
authors.lastname: Heikkinen
authors.forename: J
authors.initials: J
authors.lastname: Lahtinen
authors.forename: R
authors.initials: R
authors.lastname: Paone
authors.forename: T
authors.initials: T
authors.lastname: Juvonen
authors.forename: F
authors.initials: F
authors.lastname: Biancari
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065227:Transfusion Reaction
keywords: Octaplas®; Transfusion; cardiac surgery; coronary artery bypass surgery; fresh frozen plasma; platelets; red blood cell